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Doctor, Will My Child Have a Scar?

“So, doctor, will my child have a scar?”

As a plastic surgeon, I am asked that question all the time.  Whether it’s a cut on a knee from a fall off a skateboard or an injury to the forehead from a swingset, parents are concerned about the appearance of a scar following their child receiving stitches. The truth of the matter is that, yes, there will always be a permanent scar following any injury requiring stitches. Just how noticeable that scar will be to the casual observer, however, is what’s important.

What exactly is a scar?

Stedman’s Concise Medical Dictionary, one of the more popular references used by health care professionals, defines a scar as “any fibrous tissue replacing normal tissue destroyed by injury.”

When a skin wound is caused by an accident, stitches are placed to hold the tissue together until the body’s natural healing process repairs the wound.  This process usually takes place within five to seven days and the stitches can be removed.  Though the wound is said to be “healed”, the resulting scar, made of living tissue, is considered “immature” and will undergo a variety of changes over the next 12-18 months before taking its permanent appearance.  This period of time is called the scar’s “life cycle” and the process of change called “remodeling”.  This entire maturation process- from the initial placement of stitches to the final phases of scar remodeling-  is influenced by a variety of factors.  Some of these can be controlled; others cannot.

Factors We Cannot Control

1. Genetics. Genetics plays a huge role in the ultimate appearance of a scar.  Individuals with fair skin, light hair, and light eye color have a greater tendency to develop reddened and raised scars.  Individuals with dark hair, dark colored eyes, and olive to dark skin, in contrast, form scars that blend better with the person’s own skin color.

2. Location. The location of the wound influences the scar’s ultimate appearance.  A scar close to the shoulders, elbows, and knees, where there is a lot of natural motion and therefore tension, will widen during the maturation process.  This widening is in contrast to scars on the cheeks or forehead which heal in a fine line because of the relatively little motion present on these parts of the body.

So what can you do to reduce scarring?

1. Have your wound stitched by a qualified physician. The skill of the medical practitioner placing the sutures will affect the outcome.  Meticulous attention to detail, careful technique, a tension free closure, and fine sutures can all result in improved scar shape and appearance.  Among doctors, plastic surgeons pride themselves at being the best at placing sutures that minimize scarring and are often called upon in situations where scarring is a concern.

2. Protect scars from the UVB rays of the sun. Protecting scars during their maturation will help them take on the color of the individual’s natural complexion.  Scars overexposed to the sun during maturation will take on a reddened or cranberry colored appearance.  Sunscreen with at least a 30 SPF has been shown to be effective at minimizing scar reddening.

3. Firmly massage the scar with an oil-based moisturizer. Doing so has been shown to help keep the tissue soft and flat.  The physical manipulation of the scar works the magic.  A massage from 3-5 minutes, once or twice daily, can help flatten and soften the scar and improve its appearance on your skin.

TV and print ads are loaded with advertisements for gels, lotions, and creams claiming to “erase” and “eliminate” scars.  These remedies tend to be very expensive and their effectiveness is not supported by scientific studies.

4. Get an evaluation by your doctor. For those individuals whose scar becomes persistently red or raised over time an evaluation by your doctor may determine if certain scar treatments are right for you.  Silicone sheeting (Mepiform) and gels (Scarguard) applied to the surface of scars or cortisone injections into the scar have been proven to be effective in improving the appearance of scars.

So, for all of you parents out there wondering if your child will have a visible scar, you now have some tools at your disposal to minimize the appearance of any scars.

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About the Author: Dr. Michael J. Lacqua completed his Plastic Surgery training at the University of Missouri, Kansas City before returning to his hometown of New York. He is the Chief, Division of Plastic Surgery, at Richmond University Medical Center, Staten Island, NY.

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